No. If you care for a parent with dementia, you can be excluded from Medicaid work requirements as a family caregiver. Medicaid work requirements are a community-engagement rule that asks certain adult enrollees to document work or similar activity to keep coverage.
The exclusion covers a parent, guardian, caretaker relative, or family caregiver of a disabled person. Dementia that limits thinking, remembering, or self-care can meet the disability test. You must still claim the exclusion with your state.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- Read the official guidance from CMS — Use this primary source to verify the official guidance.
- Check eligibility on Aje Dc’s official study page — Use this page to check the study’s participation requirements.
Table of Contents
- Who must meet the rule?
- Why dementia caregiving fits the exclusion
- How do you claim the exclusion?
- When are you outside the rule entirely?
Who must meet the rule?
The rule comes from Congress in Public Law 119-21 (H.R. 1), signed July 4, 2025. According to the Centers for Medicare & Medicaid Services, states generally must implement it by Jan.
1, 2027 CMS interim rule fact sheet. It applies only to a narrow group. The Centers for Medicare & Medicaid Services limits the rule to non-pregnant adults ages 19-64 without Medicare in the adult expansion group or certain demonstration groups. Advocates for Justice and Education summarizes the test for covered adults as 80 hours per month of work, school, work programs, or community service, or at least $580 in monthly earnings.
Why dementia caregiving fits the exclusion
Federal rules list a family caregiver of a disabled individual as a specified excluded individual. According to SpecialNeeds.com, community engagement is not a condition of eligibility for that person explanation of the disability caregiver exemption. That means the work test does not decide your eligibility once the exclusion applies.
Disability uses the Americans with Disabilities Act test. An impairment that substantially limits thinking, remembering, or self-care counts, and people of any age can qualify. According to Justice in Aging, family caregiver includes an adult family member who gives broad regular help, including sons, daughters, spouses, siblings, and grandchildren Justice in Aging analysis.
How do you claim the exclusion?
The exclusion is not automatic. You must tell Medicaid you are a caregiver and meet state verification rules. Justice in Aging notes that states keep choices about implementation, so the exact process depends on where you live.
Ask your state Medicaid agency what it requires, then gather proof. Keep the papers together and ask how often you must renew. Rules can differ by state. Contact your state Medicaid agency before you assume a form or deadline.
- note your relationship to your parent
- describe regular help with meals, medicines, safety, appointments, or daily care
- get a clinician note that dementia limits thinking, memory, or self-care
When are you outside the rule entirely?
Some caregivers never enter the work-rule group. ElderCare Index places people age 65 or older, people covered through aged, blind, or disabled pathways, nursing-home residents, and home and community-based waiver recipients outside the rule.
A home and community-based waiver pays for care at home instead of a nursing home. You do not need a caregiver exclusion if the rule does not cover you. If your Medicaid group changes, ask whether the work rule now applies.
